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Immunohistochemical clinicopathologic correlation and OCT analysis of idiopathic and secondary epiretinal membrane
Athar Shadmani1, Aretha Y Zhu2, Ajay E Kuriyan1
1Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.
Aim:
To investigate correlation of clinical, optical coherence tomography (OCT), and immunohistochemistry (IHC) in idiopathic and secondary epiretinal membrane (ERM).
Methods:
Retrospective review of patients undergoing pars plana vitrectomy with membrane peeling (PPV-MP). Excised membranes were evaluated by IHC staining for glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA), cytokeratin, pigment, and fibrosis grading. Pre-operative and post-operative OCTs, and clinical follow-up information at least 3mo were collected.
Results:
This study analyzed 104 eyes of 104 patients, of whom 83 (79.8%) had idiopathic ERM (iERM) and 21 (20.2%) had secondary ERM (sERM). Mean age at the time of surgery was 67.3±10.5y. OCT demonstrated greater foveal distortion (P=0.012), intraretinal (IR) spaces (P=0.009), and ellipsoid zone (EZ) discontinuity (P=0.022) in sERMs. Poorer pre-operative BCVA for all cases correlated with foveal distortion (P=0.011), loss of parallelism (P=0.014), IR spaces (P=0.027), and EZ disruption (P=0.012). Poorer post-operative BCVA for all cases was associated with foveal distortion (P=0.027). GFAP was expressed in nearly all ERMs (99%). Pigment was expressed more in sERM (61.9%) compared with iERM (21.7%; P=0.005) and associated with poorer post-operative BCVA (P=0.035) and ERM dehiscence (P=0.008). Fibrosis severity correlated with poorer pre-operative BCVA (P=0.027). GFAP intensity correlated with longer symptom duration (P=0.002).
Conclusion:
The high prevalence of many cell types not distinguished for iERM versus sERM suggests a common pathway of formation with local influences rather than an etiologic cell type or substrate location.
Insights
Idiopathic and secondary epiretinal membranes (ERMs) share common cellular pathways, with differences in pigment expression correlating to outcomes. Optical coherence tomography (OCT) findings reveal distinct structural changes in secondary ERMs.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Pathology
Background:
- Epiretinal membranes (ERMs) are a common cause of visual impairment.
- Distinguishing between idiopathic ERMs (iERMs) and secondary ERMs (sERMs) is crucial for understanding their pathogenesis.
- Clinical, imaging, and histological features may offer insights into ERM formation and prognosis.
Purpose of the Study:
- To correlate clinical, optical coherence tomography (OCT), and immunohistochemistry (IHC) findings in idiopathic and secondary epiretinal membranes (ERMs).
- To investigate potential differences in cellular composition and structural changes between iERMs and sERMs.
- To identify factors influencing visual outcomes after surgical management.
Main Methods:
- Retrospective analysis of 104 eyes undergoing pars plana vitrectomy with membrane peeling (PPV-MP).
- Immunohistochemistry (IHC) staining of excised membranes for glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA), cytokeratin, pigment, and fibrosis.
- Correlation of pre-operative and post-operative OCT findings and clinical data with IHC results.
Main Results:
- Secondary ERMs (sERMs) showed greater foveal distortion, intraretinal (IR) spaces, and ellipsoid zone (EZ) discontinuity on OCT compared to idiopathic ERMs (iERMs).
- Poorer pre-operative best-corrected visual acuity (BCVA) correlated with foveal distortion, IR spaces, and EZ disruption.
- Pigment expression was significantly higher in sERMs and associated with poorer post-operative BCVA and ERM dehiscence. GFAP expression was nearly universal.
Conclusions:
- The high prevalence of common cellular markers suggests a shared pathway in ERM formation, influenced by local factors rather than distinct etiologic cell types.
- Structural abnormalities identified by OCT are associated with visual acuity.
- Pigment presence in ERMs is linked to worse surgical outcomes, highlighting its potential role in pathogenesis.
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